Provider Demographics
NPI:1477293314
Name:OKSILOFF, ASSENKA (LAC)
Entity Type:Individual
Prefix:
First Name:ASSENKA
Middle Name:
Last Name:OKSILOFF
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NJ
Mailing Address - Zip Code:08555-0262
Mailing Address - Country:US
Mailing Address - Phone:609-529-1568
Mailing Address - Fax:
Practice Address - Street 1:55 NEPTUNE BLVD
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4838
Practice Address - Country:US
Practice Address - Phone:732-767-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00629600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health